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02060039 CITY IL F GtDPERTONNO P IT CONTRACTOR INFO TION: BUILDINGADDRESS: _ PERMIT NO. 21261 GARDENA DR TRUNG VAN NGUYEN 02060039 OWNER'S NAME: APPLICATION SUB DATE TRUNG VAN NGUYEN 06/06/2002 O PHONE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH - � I_7 LJ L. J I_.I Z m Z - LICENSED CONTRACTOR'S DECLARATION Job Description O m—G❑ I hertby aFrtn mm 1 a 1 cenud der pro cion of Chaprcr 9 kommencing FSt 'wWg Caen]000)ofD ,onJof thaB nness and Profasiom Code.dntl mylicenee BATHROOM REMODEL/REPLACE SINK, as m full farce and ff et s s uttnxclmx sea« ADD JACUZZI ' ..-,.• �Comrator a0�n i�gs � tar v,v• CHITECT'SDECLARA ON �Bu�l�� '... . �j tTc f rinperstNitl mYV11ro shq�l'be uxd es public t�cards YYSi [7w(hkti•' j ','t y U�N 11 c.y 9 a Licensed Professional - ,gr�a at11.OWNER-BUILDER m the CoATION AUG 0 Lv 2002 c inn chat I em exam i from the Comrmior's Littne Lew for the t << following reeson.(Section 703 L5,Business and improve, dem li Code Any my or county' ° mesh Zai raa n peals t, re +het.alter,reprove dcmobsh,or repair arty swcmrc areata ssnsed Panama,ala a the Pe appl cam far Contrauch to a Lim a Law(Chmmem _ tWcho-slcegsed othe Provisions of the Contractor Littme Law...Cer9 .,,Fti>~loor Area t, LLanOn term pial Secho'7000)or Orviaon J oP the Baleen anJ pprofessions Code) ..1.. or that the it exempt therefrom and the haps for the alleged calmpdon.Any violation of Section 7031.5 by any npphemi for a Permit subjecu the applicant a civil penalty •of not mon than Eve handed dollars($ 5w). til a -.., Occupancy Type °L an"my of the Property,ser my employe with wages a their sole compensation. will do the work and the atmnure isnot intended or offered for sets(Sea.]Bt4; - 'Busineu and Professions Code:The Contractor-s Liceme law does not apply,a ea 102 - PIERS Required Inspections owner of propeny Who Wilds or improves thereon,and who data such work himself or mrou h his own employees.Provided Nat such 1mproements arc not intended or 103_,7., UFER.. q em' or ale:R.however,the l hvebuilding or Improvement Prov n that chid one yeti of completion,the ..of in.).wJl have the burden of prov ng,hmi he did not build or 1 04 — REBAR improve Tar parpon anme.). 105 - ANCHOR BOLTS - "°Iesowerofjecpropertyamexymn lydProfeisiwinhcenuI.aomuecannro 106 - SEWER & WATER C conswet the projm(Sm.7044,Business and Professions Calk)The Contractors � :: License Law does not apply t nOwner ofproperty who build+orimproves charter; 202 — UNDERFLOOR PLUMBING t .` .esti 1W a mmcn f."such projau with.a.contractions)1¢emed.punuant to me. .... ... . it.&,Lt..1.. _ ..2.03...=. .UNDERFLOOR-MECHANICAL.__ em amps under Sec B&PCforthiereason 204 - UNDERFLOOR* FRAMB ° °ajB1/O6 2 05 - UNDERFLOOR INSULATION WORKERS OMPENSATION DECLARATION' he by e(firm r�e(peneltypl pe0 ry one oLihetdl- Ino dedareumso 301 — ROUGH ,PLUMBING 302 TUB &'.OR SHOWER ; ° t.ha a end will ma t Ia a Cam mate of Content ro self-insure for Warker'e Co pe anon, u provided for by Section 3700 of the LaWr Cade, far the 303 - ROUGH MECHANICAL Pertarnenee orale work for wnien alta a<rmanIaaaw,,,, . 304 - ROUGH ELECTRICAL °I have vial will maintain Wimmi a Cbmpene,ionInsurance.as squired by Section 305 - FRAME 37W of the Labour Cud.,for the pertarnm oo of the'work'for which this permit hi - issued.MyWay trfiCompensationInsurancecarrierandPolicynumberart: 306 — HOLDOWNS . .. . . _. .. .., .. . +Sala • ' .'• :f'" "PoheyNo.: 307:. - ,:INSULATION CERTIFICATION OFEXEMY ONFROM WORKERS'. 308 = •SHEETROCKCOMt (Thu aacha need not be completed if the pe .. .309...�: ERTERIOR LATH .., .., .,...,.. (3100) noir is for one hundred dollars gele.j - 310 INTERIOR LATH 1 mfr ibaa in to t ifmmankq(the 's m Wwhich this permit is res ed,i - 32:1" '= SCRATCH- ,COAT --..... .... •. hull a t mPl Y`vny person y id21(nsur so m became se e,,o,n W en' compo e"on wsofC llf .Des!" 1Pi 313 - ROOF NAIL "fyp° 501"- FINAL ELECTRICAL' ENERGY PLICANT If ager rook' enificate of Ea mpnon,you should Z hoc baa iotheWorkrsCompensationp smmofthe laborCall,yumost 502 - FINAL PLUMBING ENERGY C wnhsdhp nimaonmsp mnanmlb attmdevotrd 503- FINAL MECHANICAL ENERGY Ih hereby _ .._ . .. .. .. ..... . ... P forth ith Com I f~' armewherebya corvsraucrloNLENDiNcncENcv 504 — FINAL BUILDING ENERGY ' y Rich that my a comamamn 1 riding agency for the performance which peal, sissuN l5 dJ097;Ci C) y'q -Londe Name . _-50.5. ..-..,FINAL -ELECTRICAL __ .. . .. .. .,. pz LeM„Ata11 1 506 - GAS TEST , a� [I arm m comply wi hth.Applicationond „ mrimy move information iron 507 - FINAL PLUMBING fps:�•.., eeWil 1 ag to comply mall city o❑ my b d sec I lar g Wddmgrondone construction. for yvumou.puposes. rvp of ihiscny teener upon 508 - FINAL MECHANICAL }} W. the eW xpi nedpropinde ins andkephar e. 509 — FINAL GRADE Fi gL (Wlegrce:m<rocsdemnifyandkttphrmlcxithe ch)ofCupyninoag`ainn 61,11,r+ fn tliab litres Iudgmcpu c su and expenses nice may in any y accrue against said 510 - FINAL L ING (,) z City in eomequi ence of the sh ng of this p reit ' ;u PucS 1 L.,Dl1RST\ND5 AND tN ILL c; .1pLY enH LI NON-POINT” � g�..4 �� C WORKS sr LR EREGUt-\ ONS 06 0, IssuedU Date gn mmot ApplimduU met - "Date' Re-roofs HAZARDOUS MATERIALS DISCLOSURE . .Will the applicant or fumte Wilding necupaat More or handle hazardous named.] Type of Roof ... .,. : .... ..... _. ._ _..__ ... . . . - .. m fined by the Cupertino Flunimpal Code ChaCharter 9.12.anti rhe Health ...and Safety Coda Section 25532m)l m . . - .• .' . °Y "°: All roofs shall be inspected prior.to any,roofing material being installed..... Will the applicant or future building melin ,use egmpmenl or devices which p pp agree to remove emn moa rdous air conem n is as defined b3,h Boy Art.Av Quality Management g - • District? p g d will comply with a Too is installed without first obtaining an inspection; I °Yav all new materials for inspection. Applicant understands an �"° - '' all non-point soiirce regulations. 1 have read,he haiallous materials requirementn under Chapter 6.95 of the Caltfo in Health&Safety Code,Sections 25505 25533 and 25574.l understand the, ifine Wilding does not currently have mnont.chathis myr pansith I, to notify the 'adupom of the requirements which mus,W m l prior, lance of a c1mifiwe of cupancy. .' .. ' 06 D6 Signature of Applicant Date a canerp qu,hadapaage.,: Data All roof coverings to be Class `B"or better „ - _,... ..-. ... OFFICE. ., ... CAf, CaTA gh a E 6N1r1-y O C©sET 8 �� 1OF3 ff r, 00oer 21 3F2'' C�iUPERfN� CRgs°1 - - 16 PIT ghp TUB w,�,��► _ (S'� f71dew� ( 32lix Sr- ) . ®� eo & / I l+ F APPRO{ej " A D DINANr' D DAT tom/ �'0 �N 0 2002 SIGNED _ d p f This set plans a s By ---- be kept onn pecifications A9UST the at all times and it is un / 3o116Fgt� Iawh i in ;av chennes or alterations 1y' nfS�omm/e�wteout w-ittely of p rmissfon from \ l artino. FA M' L / Th'Sj i9daif d of th. plan an spe ifications SHALL NOi befield to perm t or to be an approval of the violation of ny provlsfon• nf any City Ordinance or State Law_ �.{iiPPl►a KITC, � • �N�jr X002 . :[��Y -J- Lw—ft! >Q P, 3,01x 12 CIL Er AFFEI 1% e � aW'x Ick � 1OF3 f► ; µt► tRiINO � WirvOfaw - ._ of CM (3 Fq -� )(I}F 9 CE COPY RM !A of (tams and specifications MUST u be kept on the job at all times and it is un - 9 B:mP�al to make any changes or alterations ... \n sarme without vidden 'permission from ( _ `"1PpR- 4\bmilding Npt., City of Cupertino. ` �,J�btgt� oa ;P The e-tmping of this plan and specifications 3 — \"Atk NOT be held to permit or to be an .,q — w n. omww . m.) SII YYI U /01 call bF�" JUN 0 4 2002 f 3 � SUBMITTAL rFA L y A o o A-411 ��. r1 , G�i;vnnZy- • rKiTCH I\J